California Licensed Incident Management Specialist

Job Summary

Resolving moderately complex grievances and appeals, the full-time California Licensed Incident Management Specialist will investigate cases, communicate with members and stakeholders, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases by investigating and preparing documentation for medical committees
• Collaborate cross-functionally to resolve member issues related to health care delivery and benefits
• Perform case management activities, ensuring compliance with internal and external regulations while documenting case details accurately

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field AND minimum two (2) years of experience in health care or health insurance
• Alternatively, minimum five (5) years of experience in health care, health insurance, or a directly related field
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships